During my third-year family medicine rotation, I had the distinct pleasure of working in a clinic on Day 1 of their implementation of electronic health records. This was actually my first introduction to EHR systems in an outpatient setting—and my love-hate relationship with them began that day. While the ability to actually read the notes and graph out patient data was extremely useful, the system that we used was clunky and ineffective. A patient encounter that should’ve lasted 20 minutes stretched out to 45 because it was hard to navigate the system. I also felt very uncomfortable not having direct eye contact with my patients, instead focusing on the computer screen and making sure I hit all of the right buttons. Now, not all EHR systems are created equally and since that first month, I have had many encounters that have run much more smoothly. It brings up a point though: Since not all systems are created equally, physicians-in-training, patients and practitioners all have a different experience and not all of them equally good. I have heard many times on the wards how doctors feel that they cannot connect as well with their patients because a computer screen is the prominent feature of the exam room.
Whether we like them or not, EHR systems are here to stay. As of January 1 they were mandated into law by the Affordable Care Act and future physicians need to learn to work with them in the most effective way possible. There are many conflicting reports on the efficacy of such systems on patient care. One study from the Journal of General Internal Medicine stated that doctors that used an EHR system provided superior health care services in comparison to paper records while another from Medical Economics showed that 70 percent of physicians surveyed thought that EHR systems were not worth it. No matter what the numbers say, we know that EHR systems are not working as seamlessly and effectively as they were meant to.
In a perfect world, these systems would not be focused on what information the insurance companies can derive from each patient encounter but instead on the sacred bond of the patient and provider, making sure that each party has clarity about the record that is in front of them. A prime example of this is the OpenNotes system, where both patients and providers can see and understand the chart and where patients actually have input on their medical records. I believe that patient engagement such as this will go far in making EHR systems meaningful and useful.
I hope that by the time I actually enter practice, some of these initial hurdles will be overcome and that I can spend time talking to my patients and not trying to figure out the computer system.
Dr. Britani Kessler is AMSA’s national president and a recent graduate of Nova Southeastern University College of Osteopathic Medicine.